=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215596416
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARA JANE HUGHES
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2019
-----------------------------------------------------
Last Update Date | 11/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 712 HILL COUNTRY DR STE 100
-----------------------------------------------------
City | KERRVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78028-6166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-890-5181
-----------------------------------------------------
Fax | 830-890-5162
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1416
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78295-1416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-558-6288
-----------------------------------------------------
Fax | 210-558-6289
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------